MtF Transsexual Surgery Abroad for M2F Transformation by Leading Board Certified Urologist
Male to female surgery, often called MtF transsexual surgery for M2F transformation or sometimes SRS surgery MtF, is done in one stage. Male to female SRS surgery includes removal of male genitalia with simultaneous creation of female genitalia. There are two basic techniques we use for creation of a new vagina: vaginoplasty using penile inversion technique and vaginoplasty using the rectosigmoid colon. Both male to female SRS procedures are best done by a board certified urologist surgeon highly experienced in this complex and challenging field of surgery.
Dr Sava Perovic vaginoplasty by means of penile inversion is male to female surgery that uses a superior, more advanced combination of penile skin and urethral flap. Other surgeons do not use the urethral flap. If the patient has normal penis size and is uncircumcised then the penile skin is probably sufficient for creation of a neovagina using this technique.
The MtF transsexual surgery appropriate for patients with a less than average penis length is vaginoplasty using the rectosigmoid colon – a part of the bowel. This male to female surgery is also advisable for patients with a circumcised penis or any MtF transgender case where penile skin is insufficient for creation of a suitably deep vagina.
Dr Perovic’s MtF patients can normally start having sexual intercourse 6-8 weeks after either kind of male to female surgery.
Transgender sex change vaginoplasty using penile inversion to accomplish the male to female gender reassignment requires 5-6 hours of surgery. The surgery is usually performed with epidural or spinal anesthesia but general anesthesia can be used depending on the patient’s preferences. This SRS surgery includes careful disassembly of the penis to its basic components with complete preservation of vascularity (vessels that carry or circulate fluids, such as blood, lymph) as well as sensitivity of all penile parts. This male to female surgery also requires simultaneous creation of all parts of the female genitalia.
The clitoris is created by reducing the glans. The new labia minora is made from the inner preputial (foreskin) layer. The labia majora is created from a combination of penile and scrotal skin.
Deep and wide pelvic space for placement of the neovagina is created between the urethra, the prostate, the bladder in the front and the rectum in the back.
The new vagina is created by joining penile skin and the urethral flap. It is very important to include urethral flap during this male to female surgery because it provides natural vaginal lubrication as well as excellent erogenous and orgasmic sensitivity. Professor Perovic NEVER uses scrotal skin for creation of a vagina during any vaginoplasty because scrotal skin is hairy and prone to chronic dermatitis with an odorous discharge. It’s an inferior choice for vaginal creation. Also performed simultaneously is bilateral orchiectomy, also known as transgender orchidectomy -- the surgical removal of both testes.
MtF patients that want male to female surgery using penile inversion should stop taking hormones at least two weeks before surgery in order to decrease risk of deep veins thrombosis (blood clots). The patient should be admitted to the medical facility one day before surgery for colon preparation or she can prepare at her accommodations following the doctor’s instructions. The entire day before surgery only clear liquids are allowed to be eaten.
After surgery, usually a patient will stay at the medical facility for about five days. She’ll have a urethral catheter for 7-10 days until she starts to urinate. The patient will need to stay at a hotel for 3-4 more days while waiting for the final physical exam by the doctor. Vaginal dilation is sometimes necessary in order to avoid introital stenosis (constriction or narrowing of the vaginal opening and passageway).
About 7% of patients experience temporary stenosis of the vaginal introitus. In the majority of cases, this complication can be solved by dilations. Occasionally, a small additional surgical procedure is required.
Male to Female Surgery Using Rectosigmoid Colon
Male to female surgery using the rectosigmoid colon is MtF transsexual surgery for patients with less than average penis length or those with a circumcised penis. It also takes about 5-6 hours but costs 20% more than vaginoplasty using penile inversion and general anesthesia is always required.
This surgery is performed through a combined trans-abdominal and trans-perineal approach. (The perineum portion of the body in the pelvis occupied by urogenital passages and the rectum.)
This SRS surgery MtF also requires carefully disassembling the penis to fully preserve all blood and lymph vessels and keep the sensitivity of all penile parts. All parts of the external female genitalia are created at the same time.
Similar to the penile inversion technique, the clitoris is created by reducing the glans. The new labia minora is made from the inner preputial (foreskin) layer and 3-4 cm of the outer layer. The labia majora is created from a combination of penile and scrotal skin. Unlike penile inversion, the vagina is created from a part of the rectosimoid colon (bowel) which is isolated and moved into the previously created pelvic space. The outer part of the neovagina is joined to the previously created labia minora and majora and the other end is closed. The separated parts of the bowel at the donor site are joined using an automatic stapling device.
Vaginas created this way have natural lubrication as well as excellent sensitivity. Unlike some surgeons, Dr Perovic does NOT use the scrotum to make the vagina during any vaginoplasty. He does transgender orchidectomy (bilateral orchiectomy) at the time as the vaginoplasty.
Preoperative preparations and postoperative care for this male to female surgery are the same as for the technique mentioned above but more patients experience constriction or narrowing of the vaginal opening and passageway – about 10%. The complication can usually be solved by dilations but sometimes additional minor surgery is needed to correct it.
